P1435: OUTCOMES OF COVID-19 INFECTION IN INDIVIDUALS WITH SICKLE CELL DISEASE OR SICKLE CELL TRAIT: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Isabella Ferreira Michelon, Isabella Silveira Pinheiro, Isabela Lino Costa, Maysa Vilbert, Cecilia Fernandes Lorea, Mathias Castonguay, Thai Hoa Tran, Stéphanie Forté
Journal: HemaSphere (2023)

Topic: 26. Sickle cell disease Background: The COVID-19 pandemic has led to more than 6 million deaths globally and it remains a public health issue. Clinical manifestations vary widely depending on several factors, including pre-existing comorbidities. Sickle cell disease and sickle cell trait are comprised of a group of conditions that affect hemoglobin, and both are the most common variants worldwide. However, the severity of COVID-19 presentation in these patients is still not well understood. Aims: We aimed to compare COVID-19 outcomes between individuals with SCD/SCT and those without SCD/SCT. Methods: On November 14 of 2022, we systematically searched PubMed, Embase, and Cochrane Library for studies of COVID-19 infection in SCD/SCT patients compared with the non-SCD/SCT population. Key exclusion criteria were not original studies and studies lacking the control group. The primary outcome of interest was mortality. Secondary outcomes were hospitalization rate, intensive care unit (ICU) admission and the need for oxygen support (invasive and non-invasive ventilation). We performed an analysis including only studies with outcomes adjusted for confounding factors and fitting all studies. Subgroup analyses were planned for the black population and pediatric versus non-pediatric patients. We also explored sickle-cell disease-related complications and the COVID-19 infection presentation. Review Manager 5.4 was used for comparative statistical analysis and OpenMeta Analyst for proportion meta-analysis. Results: Overall, 933 were screened and 22 met the inclusion criteria. These described 1725 SCD individuals, 2244 SCT individuals, and 725,340 non-SCD/SCT. In the pooled studies that performed adjusted analysis for confounding factors SCD/SCT patients were found to be at increased risk of death (OR 1.72; CI 95% 1.29 to 2.28; p = 0.0002) compared with the control group. Black individuals with SCT also had a higher mortality rate than black individuals without SCT (OR 1.73; 95% CI 1.16 to 2.59; p = 0.007). The hospitalization rate was considerably greater for the SCD/SCT population (OR 7.57; 95% CI 3.46 to 16.59; p < 0.001). Younger patients were more likely admitted to the hospital than adults (p = 0.04). In the whole study population, no significant difference was found between SCD/SCT and non-SCD/SCT in mortality rate (p = 0.08), both in the pediatric and non-pediatric population, ICU admission (p = 0.44) and oxygen requirements (p = 0.49). Regarding SCD-related complications, 27.2% (95% CI 12.9 to 41.5) of patients developed acute chest syndrome following COVID-19 infection. The vaso-occlusive crisis was reported in 24.6% (95% CI 10.4 to 38.9), and blood transfusion was administered in 26% of cases (95% CI 8.4 to 44.7). Common COVID-19 manifestations in the SCD population were fever, pneumonia, and dyspnea occurring in 47.4% (95% CI 27.5 to 67.3 %), 37.8% (95% CI 18.9 to 56.6 %), and 15.2% (95% CI 11.6 to 18.7 %) of individuals, respectively. Summary/Conclusion: Our large systematic review and meta-analysis demonstrated that patients with SCD/SCT had a higher risk of a severe COVID-19 infection and worse outcomes. Further subgroup analyses are planned to better understand risk differences between SCD and SCT. Future studies are needed to better understand the precise mechanisms leading to increased risk in those with sickle cell trait, as this carrier state is usually considered benign. Keywords: Sickle cell, Sickle cell disease, COVID-19, Sickle cell patient